Long-term observation study of Austrian patients with rheumatoid arthritis

We examined retrospectively in a long-term observation study the outcome of patients with RA in Austria. Eighty-one inpatients with definite rheumatoid arthritis (RA) completed a standardized clinical and laboratory examination 3-8 times between 1978 and 1999. The course of the disease was assessed by determining the disease activity score (DAS), 28-joint count (28 JC), 30 swollen joint count (30 SJC), proximal interphalangeal joint score (PIP), Ritchie index, Stoke index, Steinbrocker stage, and Larsen score. In a mean duration of follow-up of 10 years, we observed a statistically significant improvement in PIP, Ritchie index, Stoke index, and DAS. Steinbrocker stage and Larsen score increased significantly. A high percentage of the patients did not receive any disease-modifying antirheumatic drug (DMARD) within the first 2 years of disease. Of all drugs used, methotrexate (MTX) was continued longer than other DMARDs. The most frequent extra-articular manifestation was sicca syndrome. In our long-term follow-up, a change in treatment from the onset of the disease in the 1980s to a more aggressive treatment within the last decade could be observed. However, with respect to the significant increase in Steinbrocker stage and Larsen score as well, an early aggressive therapy is required. With respect to the association of ANA and extra-articular manifestations, elevated ANA should give rise to an exact organ screening. For the development of predictive factors for the outcome in patients with RA, it would be helpful to refer patients at risk to specialist care as soon as possible.